Psych 101 Final

What general criteria are used to determine psychopathology? Why is one criterion usually insufficient in determining that someone is mentally ill?

Criteria: deviance, maladaptive behavior, personal distress

- deviance: behavior deviates from societal norm

- maladaptive behavior: everyday adaptive behavior is impaired

- personal distress: individual report of great distress

Everyday people are somewhat deviant, maladaptive, or distressed, but when these criteria become extreme that's when abnormality exists.

Explain the role of subjectivity and why this increases disagreement between clinicians when clinicians diagnose a patient.

Diagnosing a patient who may be mentally ill is entirely subjective. There is no set of concrete symptoms, which means that errors in the diagnosis can occur (there's more agreement on serious illnesses while there's less agreement on the less severe illnesses)

Explain what the DSM-V is. How does this help clinicians to be more accurate in diagnoses? Does the DSM-V completely prevent clinicians from making errors in diagnoses?

DSM-V is the fifth edition of a book that holds the APA classification system of psychological disorders. No, in fact it leads to a inflation in diagnoses especially with new categories of serious disorders as well as diagnoses of new everyday abnormalities that may not warrant a disorder.

What do terms like "prevalence," "lifetime prevalence," "onset," "etiology" mean?

Prevalence: how common a specific disorder is during a specific time period.

Lifetime Prevalence: the proportion of a population who at some point has had a specific disorder.

Onset: the age at which symptoms of the disorder first appear in an individual

Etiology: the apparent causation and developmental history of a disorder

What's the difference between "associative features" vs. "diagnostic features/criteria?"

Associative features: characteristics that are often associated with the diagnosis but are not required.

Diagnostic criteria: criteria that is necessary for someone to be diagnosed with a psychological disorder.

Generalized Anxiety Disorder

Characterized by chronic, high levels of anxiety not tied to any specific threat.

- increased worry about everyday problems, family, work, illnesses, etc.

- physical symptoms include: trembling, twitching, dizziness, sweating, high HR, etc.

- lifetime prevalence: 5%

- onset: midlife

- 2 times more females than males

Phobias

Characterized by a persistent, irrational fear of a specific object, activity, or situation with no realistic danger

- Common phobias: heights, small spaces, storms, water, specific animals or insects, etc.

- lifetime prevalence: 10%

- 2/3rds of diagnoses are female

Panic Disorder

Characterized by sudden, unexpected, recurrent attacks of overwhelming anxiety

- accompanied by physical symptoms of anxiety

- 2/3rds of diagnoses are females

- onset: adolescence or early adulthood

Agoraphobia

Fear of going out in public places

- can arise from panic disorder, where afraid to show panic in public

- fear of being unable to get help when panicking

- can coexist with other disorders

OCD

Characterized by persistent, uncontrollable intrusions of unwanted thoughts (obsession) and urges to engage in senseless rituals (compulsions)

- Obsessions: thoughts that repeatedly intrude on ones consciousness

- Compulsions: actions one feels forced to carry out

- lifetime prevalence: 2-3%

- tenfold increase in suicide rates

PTSD

Enduring psychological disturbance attributed to an experience of a major trauma event

- symptoms: nightmares, flashbacks, emotional numbing, alienation, vulnerability

- elevated anger, anxiety, guilt

- lifetime prevalence: 7-8%

Etiology of Anxiety Disorders

Biological perspective:

- Heritability studies

- Concordance rates - modest

- Neurotransmitters (decrease GABA, increase 5-HT)

Psychological perspective: Conditioning and learning

- Acquired via classical conditioning, maintained by operate conditioning

- Biological preparedness to learn some fears more readily (Seligman)

- Evolved module for fear learning (Ohman & Mineka)

- Maladaptive cognitive patterns

- Misinterpretation of harmless situations, excessive focus on threats, selective recall of threats

- Stress

Etiology of OCD

Biological perspective

- Temperament (e.g. higher negative emotionality)

- Genetic risk

Environmental factors

- Physical, sexual abuse or trauma Infections

- Post-infection autoimmune disorder

Etiology of Trauma/Stress Related Disorders

Biological perspective

- Emotional issues and/or other mental disorders during childhood

- Environmental factors Lower SES, less education, prior exposure to trauma, etc.

Dissociative Identity Disorder

Characterized by 2 or more personalities in one person. Transition from one person to another is usually sudden and precipitated by stress.

- more often in women than men

Etiology of Dissociative Disorders

- Stress: but why does stress affect some people in this way and not others

- Vulnerability or predisposition

- Iatrogenic: physician may accidentally plant the idea of multiple personalities into a patient

- False diagnosis

- Severe emotional childhood trauma

- Ability to dissociate?

- Very controversial; etiology is very unclear

Major Depressive Disorder

Characterized by persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure

- anhedonia: diminished ability to experience pleasure

- onset: any point in life time (avg. 30-35 yrs old)

- lifetime prevalence: 13-16%

- twice as many women (postpartum and postmenopausal)

Bipolar Disorder

Characterized by both depressive and manic episodes

- Bipolar I: full manic episodes

- Bipolar II: milder hypomanic episodes

- lifetime prevalence: 1%

- onset: late teens and early twenties

Etiology of Depressive and Bipolar Disorders

Biological perspective

Genetics

- Increased concordance for MZ twins

- Neurochemcial/Brain issues NE & 5-HT (but all monamines)

- Decreased volume of hippocampus

- Decreased neurogenesis

- Hyper-reactivity of amygdala

- Hypo-reactivity of reward system

Cognitive perspective

- Learned helplessness: ability to escape, but don't even try because of uncontrollable pain

- Reformulated learned helplessness theory: explanatory style is also to blame

- Pessimistic explanatory style (esp. internal, global)

- Rumination: when something bad happens they may mull over things often

- Women tend to ruminate more

- Men tend to distract rather than ruminate

- Hindsight bias: trying to find causation in past, usually negative lens

Interpersonal factors

- Poor social skills —> punishing social experiences —> worse mood/depression —> worse social skills

- Precipitating stress

Schizophrenic Disorders

a class of disorders marked by delusions, hallucinations, disorganized speech, and deterioration of adaptive behavior

- paranoid schizophrenia: dominated by delusions of persecution along with delusions of grandeur.

- catatonic schizophrenia: marked by striking motor disturbances, ranging from muscular rigidity to random motor activity.

- disorganized schizophrenia: characterized by severely disturbed thought processes, frequent incoherence, disorganized behavior, and inappropriate affect.

- undifferentiated schizophrenia: mixture of symptoms and does not meet the diagnostic criteria for any one type of schizophrenia

Etiology of Schizophrenia

Biological perspective

- Genetics 48% (MZ twins) vs 17% (DZ twins) 46% probability w/ two parents with schizophrenia (vs. 1% risk of general population)

- Unaffected twin as same rate of schizophrenia in offspring

- Predisposition

- "Genain" quadruplets

Neurochemical factors

- Excess amount of dopamine

- Incr. DA in nucleus accumbens (postive symptoms)

- Decr. DA in prefrontal cortex (negative symptoms)

- 5-HT, GABA, glutamate all implicated

- Marijuana + adolescence + genetic vulnerability may incr. risk

- Methamphetamine use may also increase risk

Structural abnormalities

- Enlarged brain ventricles

- Decr. gray matter + white matter

Neurodevelopmental hypothesis

- Viral infection, malnutrition, obstetrical complications

- Minor physical anomalies support this theory

Other

- Expressed emotion

- Affects course of disorder, after onset

Stress

- Can trigger first episodes or subsequent episodes

Autism Spectrum Disorder

a disorder that appears in childhood and is marked by significant deficiencies in communication and social interaction, and by rigidly fixated interests and repetitive behaviors

- lifetime prevalence: 1.5%

- males account for 80%

- 30-40% fail to develop speech

- 50% exhibit subnormal IQ scores

Etiology of Autism Spectrum Disorder

- Genetic

Brain abnormality

- Brain enlargement by age 2 yrs., overgrowth in various areas of cortex

anxious-fearful cluster

Avoidant: excessively sensitive to rejection, humiliation, shame; socially withdrawn despite desire for acceptance

Dependent: excessively lacking in self-reliance or self-esteem; allow others to make decisions; subordinating one's needs to other's needs

Obsessive-compulsive: preoccupied with organization, rules, schedules, etc.; extremely conventional, serious, and formal; unable to express warm emotions

odd-eccentric cluster

Schizoid: defective in capacity to form social relationships; showing absence of warm feelings towards others

Schizotypical: showing social deficits and oddities of thinking, perception, and communication; resembles schizophrenia

Paranoid: showing pervasive and unwarranted suspiciousness and mistrust of people; overly sensitive and prone to jealousy

dramatic-impulsive cluster

Histrionic: overly dramatic; tending to exaggerate emotions; egocentric, seeking attention

Narcissistic: grandiosely self-important; preoccupied with success fantasies; expecting special treatment, lacking interpersonal empathy

Borderline: unstable in self-image, mood, and interpersonal relationships; impulsive and unpredictable

Antisocial: chronically violating rights of others; failing to accept societal norms, to form attachments to others, or sustain consistent work behavior; exploitive and reckless

Etiology of Personality Disorders

- Genetic & environmental factors

- Antisocial personality disorder: dysfunctional family, erratic discipline, parenting neglect, parenting model of explosive behavior

- Borderline personality disorder: early trauma

Anorexia Nervosa

Characterized by intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, use of dangerous methods to lose weight

- restricting anorexia: drastic reduction of food intake

- binge-eating/purging anorexia: attempt to lose weight by forcing self to vomit after meals, misuses of laxatives, etc.

- physical symptoms: amenorrhea, gastrointestinal problems, low blood pressure, osteoporosis, and metabolic disturbances

Bulimia Nervosa

Characterized by habitually engaging in out-of-control overeating, followed by unhealthy compensatory methods

- can lead to cardiac arrhythmias, dental problems, metabolic deficiencies, gastrointestinal problems

Binge Eating Disorder

Characterized by distress-inducing eating binges that are not accompanied by purging, fasting, and excessive exercise

Etiology of Eating Disorders

Genetic

- Pre-disposition, especially AN

Personality

- AN: perfectionism

- Anxiety, negative emotionality, neuroticism/issues with emotion regulation

Cultural

- Western ideal of thinness equating to attractiveness

- Roman vomitoriums

Role of Family

- Endorsing western ideals

- Modeling maladaptive eating habits

- Early abuse

Cognitive Factors

- Rigid, all-or-none thinking

- Maladaptive beliefs

How many of those who seek therapy actually have a diagnosable mental disorder?

15% of US receive treatment

- 50% have diagnosable disorder; others seek help in everyday problems

- 28% of US have diagnosable mental-health problems but only 8% receive treatment

What are the obstacles for people seeking treatment?

- social stigmas

- high cost

- limited options

How much does the degree the counselor hold important when considering a therapist?

Not as important as having a good relationship with therapist who you like and can relate with.

- PhD for more social therapy

- MD/PsyD for biological treatment

What sorts of people are trained to practice counseling?

Psychologists

- PhD, PsyD

Psychiatrists

- MD

Counseling psychologists

- PhD, PsyH, EdD

Others

- Clergy, clinical social workers, psychiatric-mental health clinical nurses, marriage and family therapists

What are the different approaches to therapy and how are they connected with the different etiological perspectives on mental disorders?

Insight (psychoanalysis) (Sigmund Freud)

- Improperly resolved unconscious, psychosexual crises

- Unconscious conflicts resulting from fixations in earlier development cause anxiety, which leads to defensive behavior. The repressed conflicts typically center on sex and aggression.

Insight (client-centered therapy) (Carl Rogers)

- Lack of unconditional positive regard to explore true self, leading to incongruence

- Overdependence on acceptance from others fosters incongruence, which leads to anxiety and defensive behavior and thwarts personal growth.

Cognitive perspective (Aaron Beck)

- maladaptive thoughts (catastrophizing)

- pervasive negative thinking about events related to self fosters anxiety and depression, and other forms of pathology

Behavioral perspective (Joseph Wolpe)

- learned maladaptive behavior

- maladaptive patterns of behavior are acquired through learning. (created through classical conditioning and maintained by operant conditioning)

Biological perspective

- something is biologically wrong

- most disorders are attributed to genetic predisposition and physiological malfunctions, such as abnormal neurotransmitter activity

What is CBT? Is it different from DBT?

CBT focuses on the link between your thoughts, feelings, and behaviors and seeks to help you replace unhelpful patterns of thinking and behavior with more helpful ones.

- very structured and often involves work outside of therapy sessions.

DBT has four primary areas of focus: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.

- helps you learn how to regulate emotions, stay in the present moment, deal with crises, and be effective in your relationships.

How might treatment from the cognitive perspective differ from treatment from the behavioral perspective?

Cognitive

- reduction of negative thinking; substitution of more realistic thinking

- thought stopping, recording of automatic thoughts, refuting of negative thinking, homework assignments

Behavioral

- elimination of maladaptive symptoms; acquisition of more adaptive responses

- desensitization is intended to weaken and replace this association

- classical & operant conditioning, systematic desensitization, aversive conditioning, social skills training, reinforcement, shaping, punishment, extinction, biofeedback

What's the difference between "systematic desensitization" vs. "flooding"?

Systematic Desensitization

- relaxation training is followed by gradual exposure to the feared stimuli starting with the least feared stimulus.

Flooding

- immediate exposure to the stimulus. Exposure therapy has been described as the most effective way to treat fear.

What are things like anxiolytics and antipsychotics?

Central nervous system depressants used to manage symptoms of psychosis and anxiety disorders include antipsychotics and anxiolytics, which may cause psychosis. Refers to any drug that modifies psychotic behavior and exerts an antipsychotic effect. Certain anxiolytics are used to treat sleep disorders, seizures, and withdrawal symptoms from alcohol or other abuse substances.

Why is ECT controversial?

Many critics have portrayed ECT as a form of medical abuse, and depictions in film and television are usually scary. Yet many psychiatrists, and more importantly, patients, consider it to be a safe and effective treatment for severe depression and bipolar disorder.

What's the difference between traditional neuroleptics vs. atypical antipsychotics? What's a partial agonist?

Typical antipsychotics tend to more strongly block dopamine. Atypical antipsychotics have greater effects on serotonin.

Partial agonists bind to and activate receptors so they function as agonists. The activation they produce is less than a full agonist.

What does "small therapeutic index" mean and for which drug is this an issue for, in particular?

small therapeutic index increases the probability of toxicity or ineffectiveness of the drug.

- Lithium

What's one of the quickest ways to address depressive symptoms?

antidepressant drugs

What are some of the challenges involved with trying to assess the effectiveness of psychopathological

treatment, whether talk therapy or biological forms of treatment? What is "spontaneous remission" and explain why this is an issue when trying to assess effectiveness of both talk therapies and biological forms of treatments?

psychopathology can differ from person to person due to genetic predisposition and vulnerability. Too great of an impact from environmental factors as well.

Spontaneous remission: a reduction or disappearance of symptoms without any therapeutic intervention, which may be temporary or permanent.

- this makes it difficult to determine whether the therapy was a factor in remission and also may cause people to believe the therapy wasn't working if temporary.

What are the pros and cons of using talk therapies?

Pros:

- someone to talk to, highly effective, root cause, coping mechanisms

Cons:

- exclusionary, breach of privacy, harm, takes time

What are the pros and cons of using biological treatments for psychopathologies?

Medication is readily available and can easily be prescribed. It is very effective, but can have serious side effects if taken improperly such as overdosing or even under using where the illness may persist.

What is "fee for service" vs. "managed care?" What are the benefits and disadvantages of managed care?

fee for service is when the physician determines the actions to take and the insurance company pays the fee. Managed plans contain specific built in cost controls.

Pro: Limit Time Away from Work.

Pro: Easy to Find Credentialed Care Providers.

Con: Lack of Freedom to Choose Own Providers.

Con: Concerns Regarding Quality of Care.

What was the deinstitutionalization movement? Was it a success? Why or why not?

This is the transferring of treatment for mental illness from inpatient institutions to community facilities that emphasize outpatient care.

There is mixed success. Many people have benefited by avoiding disruptive and unnecessary hospitalization. But many patients with chronic psychological disorders had nowhere to go when they were released. "revolving door"

What diversity issues do we have when it comes to mental health treatment?

Therapy is seen as a western value and seek help from non-credentialed providers such as priests, shamans, etc. American minority groups generally underutilize treatment due to government interactions, intimidation, and unaccommodating facilities for non-english people groups. Psychiatrists have been found to spend less time with non-white patents, who even receive less treatment for their diagnoses.

When it comes to the homeless, what do we know about mental health issues?

Deinstitutionalization is a growing factor in homelessness. 1/3rd of homeless manifest mental illness, 1/3rd struggle with substance abuse, and many struggle with multiple disorders, increasing the prevalence for the group. The government is not providing adequate care for the majority that suffer from mental illness (homeless and jail).

Antidepressant drugs

- gradually elevate mood and help bring people out of depression.

- most widely prescribed: selective serotonin reuptake inhibitors (slow reuptake process of serotonin synapses)

- Prozac, Zoloft

Side Effects

- nausea, drowsiness, sexual difficulties, weight gain, emotionally numb, agitation, and increased suicidal thoughts

- regulated by FDA

electroconvulsive therapy (ECT)

Electroconvulsive Therapy

- Electrical current (~1 sec) which triggers a seizure

- Patient awakens in 1-2 hours 2-3x per week for about 2-7 weeks/6 to 12 sessions

- Mild, short-term cognitive impairments or more severe, permanent cognitive impairments? (e.g. retrograde amnesia for autobiographical information)

- Effective for cases which do not respond to other forms of treatment.

- 75% success rate for treating depression

- Depression has been cited as the most debilitating, even above other physical illnesses.

- Relapse is high but may be so because this is used for the most severely depressed who do not respond to medication

Sleep deprivation to treat depression

cognitive therapy vs antidepressants

- Can combine talk therapy with medication to decrease dosage of medication, and therefore, the side effects

- Can treat some cases where talk therapy does not seem to be effective

- short-lived, treating symptoms not the cause (leading to relapse), overprescribed/overmedicated, severity of side effects may be underestimated

- Effects are durable (though booster sessions may be good for some to have)

- There are no side effects (vs. medications which all have various side effects)